More Money for Health, and More Health for the Money

This post is by Center Director Christine Lubinski, who is attending the 2009 IAS conference in Cape Town.

Getting the most bang for your buck may be a cliché, but it’s probably a good one for these hard economic times. Stefano Bertozzi, founding director of the Division of Health Economics & Policy at Mexico’s National Institute of Public Health, didn’t use those words in his presentation during today’s plenary session, but that was a central part of his message.

He challenged the audience by calling for more strategic spending of current funding, while also continuing to push for all the resources needed in the global battle against HIV/AIDS. Bertozzi identified developing-country domestic resources being spent on HIV prevention and treatment as the most vulnerable in the current economic downturn. For example, Botswana’s government contributes 89 percent of the resources for its AIDS programs, and yet diamond exports from Botswana declined by 89 percent in the last year.

Bertozzi outlined a number of ways to get the most health for our thinly-stretched dollars:

*Choosing interventions strategically and evaluating their effectiveness, including cost-effectiveness. Given the number of lives at stake, Bertozzi said it is “unethical” to spend millions implementing interventions without any evaluation. Many of the preventions currently being widely deployed, including abstinence programs, have not been evaluated for effectiveness.

*Better targeting of resources to the epidemic. Bertozzi used his own country, Mexico, as an example, noting that despite the fact that the majority of the infections were in MSM, the resources were not targeted to that high-risk group. Similarly, Russia directs most of its funds to school-based education, despite an epidemic dominated by IDUs.

*Improving management and implementation of programs. There are wide variations in the cost of HIV/AIDS services provided, even within countries, so in many places too much is being paid for too little, he said. We need to maximize productivity while reducing the costs of units of service.

*Supporting strategic integration with other services to maximize long-term benefit. Bertozzi said the impact measured should be life extension, not just the number of people on treatment.

For more on cost-saving ways to deliver HIV care, read this Aidsmap story, also reported from the IAS conference, on the benefits of home-based treatement.